TOPLINE

Late-life hypertension is associated with a higher risk for dementia among robust, but not prefrail or frail older adults, whereas diabetes and current smoking are associated with increased dementia risk regardless of frailty status, a new study showed.

METHODOLOGY

• Researchers conducted a prospective cohort study of 6135 adults (mean age, 75 years; 58.5% women; 79.2% White; 20.8% Black) without dementia from the US-based ARIC cohort between 2011 and 2013.
• Baseline vascular risk factors included elevated blood pressure (systolic BP, 120-129 mm Hg and diastolic BP < 80 mm Hg), hypertension (systolic BP ≥ 130 mm Hg, diastolic BP ≥ 80 mm Hg, or the use of BP medication), diabetes, and smoking status.
• Participants were classified as robust (n = 2383), prefrail (n = 2376), or frail (n = 334) based on the Fried physical frailty criteria.
• Incident dementia was determined through in-person neuropsychological assessments, semiannual participant or informant reports, and surveillance of claims from hospitalizations and death certificates over a median follow-up period of 9 years.
• Cox proportional hazards models were used to assess the associations between vascular risk factors, frailty status, and incident dementia.

TAKEAWAY

• During follow-up, 15.8% of robust participants and 30.0% of participants with prefrailty or frailty developed dementia. Diabetes (hazard ratio [HR], 1.29; 95% CI, 1.15-1.44), current smoking (HR, 1.50; 95% CI, 1.19-1.89), and prefrail or frail status (HR, 1.59; 95% CI, 1.43-1.78) were independently associated with a higher risk for dementia in the fully adjusted model.
• Hypertension showed significant interaction with frailty status in relation to dementia risk (P for interaction = .026).
• Hypertension (adjusted HR [aHR], 1.39; 95% CI, 1.00-1.94) was associated with a higher risk for dementia in robust participants, but not in those with prefrailty or frailty (aHR, 0.82; 95% CI, 0.66-1.01).
• Elevated BP was associated with a lower risk for dementia (aHR, 0.68; 95% CI, 0.49-0.95) in those with prefrailty or frailty, but not in robust participants (aHR, 1.03; 95% CI, 0.65-1.64).
• Diabetes was associated with a higher risk for dementia in both robust participants (HR, 1.28; 95% CI, 1.04-1.57) and those with prefrailty or frailty (HR, 1.29; 95% CI, 1.12-1.47).
• Current smoking was associated with an elevated risk for dementia in both robust participants (HR, 1.59; 95% CI, 1.02-2.48) and those with prefrailty or frailty (HR, 1.44; 95% CI, 1.11-1.89).

IN PRACTICE

“It’s exciting to think that even for people in their eighties, we could help preserve people’s brain health by choosing their optimal blood pressure target based on whether they have signs of frailty,” lead investigator Jason R. Smith, PhD, University of North Carolina at Chapel Hill, said in a news release. 

“More research is needed to determine whether managing blood pressure in this way could truly lower the risk of dementia,” Smith added.

SOURCE

The study was published online on June 10 in Neurology.

LIMITATIONS

The study did not account for age at vascular risk factor onset, control, or cumulative effects and trajectories, which may have affected the estimates. The primary analysis combined prefrailty and frailty subgroups due to sample size limitations. Only White and Black individuals were included, limiting generalizability, and interaction analyses may have been underpowered to assess disparities across subgroups. Associations between vascular factors and dementia subtypes were not examined.

DISCLOSURES

The study was funded by the National Heart, Lung, and Blood Institute; the National Institutes of Health; and the Department of Health and Human Services. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.